Tubal Pregnancy Symptoms

A normal pregnancy occurs when a fertilized egg travels through the fallopian tube to the uterus, and attaches itself to the uterine wall. An ectopic pregnancy is when an egg attaches itself to something other than the uterine wall. The egg in an ectopic pregnancy usually implants itself into the fallopian tube.

So, a tubal pregnancy is a type of ectopic pregnancy.

A tubal pregnancy occurs when an egg implants itself into the fallopian tube. A tubal pregnancy is frequently triggered by damage to the fallopian tubes. A fertilized egg could have a problem passing through an impaired tube, triggering the egg to attach and develop in the tube.

Some things that can make damage to a fallopian tube more likely are smoking, pelvic inflammatory disease (PID), endometriosis, and being exposed to a chemical called DES before being born. The more one smokes, the higher the risk for an ectopic pregnancy. Pelvic inflammatory disease is usually the consequence of an infection like chlamydia or gonorrhea. Endometriosis causes scar tissue or damage in or around the fallopian tube, making a tubal pregnancy more likely. Women who are exposed to DES in utero are more likely to have misshapen reproductive organs, making having a complicated pregnancy a greater chance, including tubal pregnancy.

Heterotopic pregnancy and its features

There are some seldom cases when the tubal pregnancy is compatible with the physiological one. In this case one fertilized egg is situated as it is described above, and the second is situated in the uterus. The modern medicine opportunities and highly qualified surgeons allow to eliminate the pathologically attached embryo, preserving the viability of the normal fetus. Note that the sooner the problem is found, the more chances of a positive result exist.

The consequences of the pregnancy developing in the fallopian tube

In case of tubal pregnancy removal, it is necessary to pass the drug therapy. It includes physiotherapy, acupuncture, selection of the correct contraceptives. The woman also needs antibiotics, anti-inflammatory and restorative therapy. The pathology effects may be different: everything depends on the time and the method tubal pregnancy termination. The chances of the natural impregnation and following maternity are 50 %. In 30% of cases, the infertility occurs (usually, in case of repeating pathology and the complete fallopian tubes removal). The frequency ectopic pregnancy recurrence is defined at 20 %. The consequences of the disease include adhesions in pelvis, pain, menstrual disorders, hormonal imbalance and psychological problems. In case of the re-conception a woman should be under the experts’ careful attention from the very first days of the delay. This will help to detect, adjust or contradict a relapse.

Risk factors of the tubal pregnancy

The reasons why the ectopic and tubal pregnancies occur are not obvious. Of course, the first reason of the disease – is the movement disorder of the ovum. However, it is difficult to stipulate the immediate reasons for this occurrence, so the doctors talk about risk factors of tubal pregnancy. There are many factors associated with this pregnancy, which is not surprising.

The risk factors include:

Previous ectopic pregnancy: You are more likely to have this pregnancy if you have had a previous one.

Infections or inflammations: An infection of the ovaries, fallopian tubes or uterus or an inflammation of a fallopian tube will increase your risk of having an ectopic pregnancy. The infections are often caused by chlamydia or gonorrhea.

Contraception choice: It is rare for a woman to get pregnant while using an intrauterine device, but if conception occurs, it’s highly likely to be ectopic. This is also true for pregnancy that occurs after a tubal ligation, which is a permanent birth control method known commonly as tying the tubes.

Structural damages of the fallopian tubes.

Cigarette smoking: You have a higher risk if you are smoking right before getting pregnant. The risk will get even greater if you continue to smoke.

The main anatomical background for such state formation:

adnexal affection process (salpingo – oothecitis);

surgery on the tubes;

intrauterine contraception.

The main reason for the pregnancy in the tube is acute or chronic salpingitis or the fallopian tube inflammation. The patient with acute adnexal affection risks more in 6 times to obtain the tubal focalization in comparison with the healthy woman. During the process of salpingitis, the fallopian tubes contractility and patency is violated. At the same time the synthesis of substances, which ensure the natural ovum passage into the uterus, is violated too. There are some ovaries hormonal function changes, which are often involved in the inflammation process. This enhances the fallopian tubes disruption.

The intrauterine contraceptives usage leads to the cessation of cilia movement lining the tubes and promoting the fertilized ovum into the uterus. Women who use such method of contraception have in 20 times more the frequency of the ectopic pregnancy than those who use other measures for the birth control.During many diseases, there are some operations on the appendages, which greatly increase the risk of developing the pathosis. The likelihood of this result depends on the scope of the operation, equipment, access (laparotomy or laparoscopy) and other factors. If a woman has previously been operated because of such pregnancy, the risk of recurrence of such a situation increases to 16%.

When a woman has had two or more induced abortion, the risk of her fetus ectopic location increases significantly. Additional risk factors are infantilism, malformations or uterus tumors and appendages and endometriosis.

There are some hormonal risk factors:

the drugs usage for ovulation induction to treat infertility;

in vitro fertilization;

delay of ovulation;

ovum transmigration.

Read also:

Symptoms of a Tubal Pregnancy

Some signs of a normal pregnancy can occur such as nausea, breast tenderness, mood swings, changes in vaginal discharge, tiredness, and a missed period, among others. If the pregnancy develops without a doctor identifying the pregnancy as tubal, complications will occur and can be life-threatening. A tubal pregnancy does not have the ability to grow into a normal, healthy baby.

The signs and symptoms of a tubal pregnancy typically start six to eight weeks after the last menstrual period. Although some signs and symptoms are more classic, for instance nausea, tiredness, and breast tenderness, others are not so standard, for example, pain during intercourse, irregular vaginal bleeding or spotting, cramping, pain on one side or in the lower abdomen, a fast heartbeat, and passing out or experiencing pain while having a bowel movement or passing urine. These can be signs that there is internal bleeding going on and that can be extremely hazardous and even life threatening.

A tubal pregnancy can become ruptured. A ruptured tubal pregnancy comes about when the fallopian tube gets torn or bursts and causes internal bleeding. Usually, there is severe stomach pain that, on occasion, goes along with vaginal bleeding. Having a tubal pregnancy can be a life-threatening experience if not caught in the early stages. Abrupt, intense pain in the abdomen and pelvis, weakness, dizziness and/or fainting, and pain in the shoulder are all signs of a ruptured fallopian tube and internal bleeding. If left untreated, this condition can lead to a blood transfusion, abdominal surgery, or even death.

A tubal pregnancy may have the symptoms of a sharp, sudden pain in the lower abdomen. The pain can be sharp, on one side at first, and then spread throughout the stomach. The pain has the possibility of becoming more intense or concentrated with movement or strain. The intense pain could be accompanied by irregular or heavy vaginal bleeding. If there is a lot of internal blood loss, there could be dizziness or fainting caused by blood loss. Nausea and light-headedness are also a sign of severe blood loss. If any of these symptoms occur, the best bet is going to a doctor right away.

In sometimes a woman suffering from a tubal pregnancy will experience the same symptoms as miscarriage. Which includes stomach pain, bleeding, and the absence of menstrual periods, which is also known as amenorrhea. Heavy vaginal bleeding or bleeding that occurs before 12 weeks of gestation could mean a serious problem, including a tubal pregnancy or miscarriage. It is important to mention that having these symptoms does not mean there is a tubal pregnancy taking place all the time. As specified earlier, some women will initially have no signs while others will experience severe symptoms of a tubal pregnancy. A doctor is the preeminent person to seek a medical diagnosis of this condition.

The process and signs of the tubal pregnancy

The fertilized egg in the wall of the pipe is covered by its mucous membrane. The growth of this sheath thins and breaks down. At the same time, the degenerative changes occur in the muscular wall of the tube; the fertilized egg is not sufficiently supplied with blood and dies. The fallopian tubes begin to make antiperistaltic reduction where the ovum enters the abdominal cavity. In case of its viability, there is a probability of its attachment to the abdominal wall and the formation of the repeated ectopic pregnancy. Simultaneously, with the ovum expulsion in the tube wall, the bleeding occurs. Blood with antiperistaltic cuts enters the abdominal cavity. As a result, the tubal abortion occurs.

The pipe rupture occurs because of the body walls destruction with the growing fertilized egg and is accompanied by intra-abdominal bleeding.

The terms of the ectopic pregnancy termination, as well as variants of such termination are determined by its location. If the ovum is situated near the pipe mouth opening into the uterus, the disturbed tubal pregnancy will occur about in a month after fertilization, according to the type of pipe rupture. The localization of the embryo in the middle part and its development may take up to 16 weeks because of the thick muscle layer and the good vascularity. However, during the gap in this part, there is a strong bleeding that can lead to woman’s death. If the pregnancy develops in the ampullar part, it is interrupted in 4-8 weeks as the tubal abortion.In some cases, the missed tubal pregnancy is formed when the lost ovum gradually absorbed or calcified. In this case the termination does not occur.

Very often the symptoms of the tubal pregnancy are erased, non - typical and diverse. The progressing pregnancy in the fallopian tube accompanied by the same signs as normal:

there is no menstruation;

there are some taste and smell changes;

nausea;

vomiting and breast tenderness.

In case of pipe breakage the woman suddenly feels severe pain in the abdomen, extending into the rectum and the shoulder blade. They are accompanied by signs of internal bleeding – paleness, cold sweat, frequent pulse, drop in pressure, dizziness and loss of consciousness. There is a strong pain during the cervix displacement in the opposite side of the lesion. On examination the posterior vaginal vault bulges. There is some dark blood does not clot during the puncturing. Some slight bleeding appears from the genital tract.

Interrupted tubal pregnancy as the tubal abortion is often accompanied by mild symptoms – aching pain in the abdomen and menstrual irregularities. The additional research methods have the most crucial meaning in the diagnosis.

In addition, some medical procedures can make a tubal pregnancy more likely.

Those procedures include surgery on the fallopian tubes, surgery in the pelvic region, tubal ligation, and fertility treatments like in vitro fertilization. Surgery on the fallopian tubes or the pelvic region increases the likelihood of scarring in that region. Women who have in vitro fertilization have about a two percent chance of having a tubal pregnancy. Although women with a history of damaged tubes or ectopic pregnancy have an even higher risk.

A tubal ligation—also known as having your tubes tied or tubal sterilization—is a kind of eternal birth control. During a tubal ligation, the fallopian tubes are cut or blocked to forever prevent pregnancy. A tubal ligation upsets the movement of the egg to the uterus for fertilization and blocks sperm from traveling up the fallopian tubes to the egg, but it does not affect the menstrual cycle. During the first year after a tubal ligation, it’s assessed that less than one in one hundred women will get pregnant.

The younger a woman is at the time of a tubal ligation, the higher the risk of sterilization failing. If the egg does become fertilized after having a tubal ligation, there's a higher chance that it will be a tubal pregnancy. Although tubal pregnancy after sterilization is not common, it is also not rare. Many tubal pregnancies occur a long time, even years, after the sterilization procedure. They also transpire more commonly in women who have undertaken the sterilization procedure before the age of 30 years and in those who have had histories of inflamed fallopian tubes (pelvic inflammatory disease). It can be concluded that all women go through the tubal ligation procedure should be mindful that tubal pregnancy can take place many years after sterilization.

How to prevent a tubal pregnancy?

There are things you can do to minimize your risk. Among the controllable factors that contribute to a heightened risk for ectopic pregnancy are surgical sterilization and treatment with progestin single hormone contraceptives. Fertility treatments also increase the risk of ectopic pregnancy as does smoking cigarettes and douching on a regular basis. Sexually transmitted diseases (STD's) put you at risk for pelvic inflammatory disease, which can damage the fallopian tubes and put you at risk for an ectopic pregnancy. Practicing safe sex is the best way to prevent these and other catastrophes that can affect your health and wellbeing.

Diagnostics:

The main method in case of suspicion for this pathology is transvaginal ultrasound. Primarily it is aimed at identifying signs of uterine pregnancy that allows almost completely elimination of the tube ovum localization. When using particular vaginal sensors, the fertilized egg in the uterus can be already detected after 1.5 weeks of the fertilization. In order to confirm germ tubular localization, it is necessary to pay attention to the fallopian tube forming and to the presence of fluid in the abdominal cavity. Of course, the most informative is the detection of the developing ovum outside of the uterus. However, the progressive tubal pregnancy diagnosis percentage does not exceed 5-8 occurrences out of 100.

An additional diagnostic method is the determination human chorionic gonadotropin level, using qualitative or quantitative methods. Absolute values, which are the criterions of the ectopic pregnancy, do not exist for this indicator. However, in most cases, its level in pipe location is lower than normal. The research in dynamics is too important. With uterine pregnancy the concentration of human chorionic gonadotropin doubles every two days, while during the tubal pregnancy it does not happen. The most informative method is laparoscopy. It allows to identify a developing ectopic pregnancy or the state after an interruption, to assess the blood loss volume, the uterus and appendages state. However, the laparoscopy should be used only if non-invasive methods do not allow to make the diagnosis.

The medication:

In case of interrupted tubal pregnancy, it is necessary to operate. The laparoscopy is more beneficial. A laparotomy is performed in hemorrhagic shock or during the severe adhesive process. During the operation, it is necessary to stop the bleeding and remove the pipe. Simultaneously, the doctors restore circulation and deal with the blood losses. In some cases, the reconstructive plastic surgery is possible that allows to save an organ.

After such surgery the supervision is necessary in order to prevent transplantation of non-remote parts of the chorion. During the recovery period the vitamins, iron supplement and physical therapy are assigned with the purpose to prevent adhesions. You must take oral contraceptives for at least six months to protect yourself from the pregnancy. Two months later, after the laparoscopy, it is advisable to hold the second intervention in order to remove the formed adhesions, to assess the patency of the fallopian tubes and to clarify the indications for in vitro fertilization.

Laboratory assessment:

It is possible to confirm the ectopic pregnancy with the help of laboratory diagnosis. For this reason the patient is required to donate blood to determine the level of two substances: progesterone and the human chorionic gonadotropin. In a normal pregnancy these values are constantly increasing in conformity with the terms. If you have values that are less, probably the embryo is implanted outside the uterine cavity. In order to obtain the precise and reliable diagnosis, you have to re-take the test in a few days. Positive dynamics or the lack of dynamics will enable to have the clear understanding of the situation.

Surgical intervention:

Laparotomies operation

Such interference is quite difficult for many patients. The recovery period has been lasting from two weeks to several months. During the manipulation the abdominal cavity is cut on layers. After this the ectopic pregnancy is adjusted. During the laparotomy the tubectomy is often conducted too. In other words, affected fallopian tube with the embryo is completely dissected. After that, it is necessary to wash the abdominal membrane and the wound is stitched in the reverse order.

The sensitive method: laparoscopy

The laparoscopic surgery is very popular in recent years. It involves two - four punctures in the abdominal cavity.

Laparoscopy allows not to remove the fallopian tube completely, but only to excise its damaged area. This operation is called robotonia. This method is chosen, taking into account the patient age, state and desires. The fallopian tube preservation allows to maintain the reproductive function. However, the recurrence of the ectopic pregnancy supposes the complete removal of the fallopian canal.